From spotlight to shadow: ALK inhibitor-induced acute liver failure in a patient with non-small cell lung cancer

##plugins.themes.bootstrap3.article.main##

##plugins.themes.bootstrap3.article.sidebar##

Vol3Nr4Y2023
Published Nov 15, 2023
DOI: https://doi.org/10.22551/2023.41.1004.10266
Simona Stefania Juncu http://orcid.org/0009-0001-5001-4852 Anca Victorita Trifan Horia Minea Raluca-Ioana Avram Camelia Cojocariu Ana-Maria Singeap

Abstract

Novel oncological therapies substantially improved the prognosis of cancer patients. Immunotherapies (immune checkpoint inhibitors) and targeted therapies (tyrosine kinase inhibitors) represent innovative strategies, which have revolutionized cancer patients approaches. However, the new treatments may bring additional adverse effects, therefore right selection, close monitoring, and appropriate clinical decisions in the event of a complication are of upmost importance in these patients' management. We present an elderly male patient undergoing treatment with alectinib - anaplastic lymphoma kinase (ALK) inhibitor for metastatic non-small cell lung cancer, who was diagnosed with acute liver failure by drug-induced liver injury, five months after the start of the therapy. After the other possible causes of hepatocellular injury were excluded, the drug was discontinued. Using corticotherapy and supportive measures, the evolution of the patient was favorable. Up to this moment, data showed that alectinib was less associated with liver function abnormalities compared to other ALK inhibitors, however most commonly of mild or moderate grade of severity, especially in the first two months of treatment. The case we report presented acute onset liver failure, with a relatively late occurrence during alectinib therapy. Timely recognition may improve patients prognosis, and monitoring must be carried out rigorously. Awareness and effective interdisciplinary communication among medical specialties play a pivotal role in the comprehensive care of cancer patients.

##plugins.themes.bootstrap3.article.details##

Keywords

targeted therapy, ALK inhibitors, alectinib, non-small cell lung cancer, drug-induced liver injury, acute liver failure

References
1. Charmsaz S, Collins DM, Perry AS, Prencipe M. Novel Strategies for Cancer Treatment: Highlights from the 55th IACR Annual Conference. Cancers (Basel). 2019;11(8):1125. doi: 10.3390/cancers11081125. PMID: 31394729; PMCID: PMC6721818.
2. Bondhopadhyay B, Sisodiya S, Chikara A, Khan A, Tanwar P, Afroze D, Singh N, Agrawal U, Mehrotra R, Hussain S. Cancer immunotherapy: a promising dawn in cancer research. Am J Blood Res. 2020;10(6):375-385. PMID: 33489447; PMCID: PMC7811907.
3. Min HY, Lee HY. Molecular targeted therapy for anticancer treatment. Exp Mol Med. 2022;54(10):1670-1694. doi: 10.1038/s12276-022-00864-3. PMID: 36224343; PMCID: PMC9636149.
4. Malnick SDH, Abdullah A, Neuman MG. Checkpoint Inhibitors and Hepatotoxicity. Biomedicines. 2021;9(2):101. doi: 10.3390/biomedicines9020101. PMID: 33494227; PMCID: PMC7909829.
5. Zhou Z, Li M. Targeted therapies for cancer. BMC Med. 2022;20(1):90. doi: 10.1186/s12916-022-02287-3. PMID: 35272686; PMCID: PMC8915534.
6. Yuan L, Kaplowitz N. Mechanisms of drug-induced liver injury. Clin Liver Dis. 2013;17(4):507-18, vii. doi: 10.1016/j.cld.2013.07.002. PMID: 24099014; PMCID: PMC3793205.
7. Katarey D, Verma S. Drug-induced liver injury. Clin Med (Lond). 2016;16(Suppl 6):s104-s109. doi: 10.7861/clinmedicine.16-6-s104. PMID: 27956449; PMCID: PMC6329561.
8. Hosack T, Damry D, Biswas S. Drug-induced liver injury: a comprehensive review. Therap Adv Gastroenterol. 2023;16:17562848231163410. doi: 10.1177/17562848231163410. PMID: 36968618; PMCID: PMC10031606.
9. Fisher K, Vuppalanchi R, Saxena R. Drug-Induced Liver Injury. Arch Pathol Lab Med. 2015;139(7):876-887. doi: 10.5858/arpa.2014-0214-RA. PMID: 26125428.
10. Teschke R. Treatment of Drug-Induced Liver Injury. Biomedicines. 2022;11(1):15. doi: 10.3390/biomedicines11010015. PMID: 36672522; PMCID: PMC9855719.
11. Clinton JW, Kiparizoska S, Aggarwal S, et al. Drug-Induced Liver Injury: Highlights and Controversies in the Recent Literature. Drug Saf. 2021;44(11):1125-1149. doi: 10.1007/s40264-021-01109-4. PMID: 34533782; PMCID: PMC8447115.
12. Chevallier M, Borgeaud M, Addeo A, Friedlaender A. Oncogenic driver mutations in non-small cell lung cancer: Past, present and future. World J Clin Oncol. 2021;12(4):217-237. doi: 10.5306/wjco.v12.i4.217. PMID: 33959476; PMCID: PMC8085514.
13. Huang H. Anaplastic Lymphoma Kinase (ALK) Receptor Tyrosine Kinase: A Catalytic Receptor with Many Faces. Int J Mol Sci. 2018;19(11):3448. doi: 10.3390/ijms19113448. PMID: 30400214; PMCID: PMC6274813.
14. Chia PL, Mitchell P, Dobrovic A, John T. Prevalence and natural history of ALK positive non-small-cell lung cancer and the clinical impact of targeted therapy with ALK inhibitors. Clin Epidemiol. 2014;6:423-432. doi: 10.2147/CLEP.S69718. PMID: 25429239; PMCID: PMC4242069.
15. Mori M, Hayashi H, Fukuda M, et al. Clinical and computed tomography characteristics of non-small cell lung cancer with ALK gene rearrangement: Comparison with EGFR mutation and ALK/EGFR-negative lung cancer. Thorac Cancer. 2019;10(4):872-879. doi: 10.1111/1759-7714.13017. PMID: 30811109; PMCID: PMC6449252.
16. Solomon BJ, Mok T, Kim DW, et al. First-line crizotinib versus chemotherapy in ALK-positive lung cancer. N Engl J Med. 2014;371(23):2167-2177. doi: 10.1056/NEJMoa1408440. Erratum in: N Engl J Med. 2015;373(16):1582. PMID: 25470694.
17. Gadgeel S, Peters S, Mok T, et al. Alectinib versus crizotinib in treatment-naive anaplastic lymphoma kinase-positive (ALKþ) non-small cell lung cancer: CNS efficacy results from the ALEX study. Ann Oncol. 2018; 29:2214-2222. PMID: 29455675; PMCID: PMC5817728. doi: 10.1186/s12943-018-0810-4.
18. Zhou C: Primary results of ALESIA: A randomised, phase III, openlabel study of alectinib vs crizotinib in Asian patients with treatment naïve ALK+advanced NSCLC [https://oncologypro.esmo.org/meeting-resources/esmo-2018-congress/primary-results-of-alesia-a-randomised-phase-iii-open-label-study-of-alectinib-vs-crizotinib-in-asian-patients-with-treatment-naive-alk-advance/ available at 11.01.2023]
19. Liu B, Yuan M, Sun Y, et al. Incidence and risk of hepatic toxicities associated with anaplastic lymphoma kinase inhibitors in the treatment of non-small-cell lung cancer: a systematic review and meta-analysis. Oncotarget. 2017;9(10):9480-9488. doi: 10.18632/oncotarget.23840. PMID: 29507704; PMCID: PMC5823621.
20. Zhu Q, Hu H, Weng DS, et al. Pooled safety analyses of ALK-TKI inhibitor in ALK-positive NSCLC. BMC Cancer. 2017;17(1):412. doi: 10.1186/s12885-017-3405-3. PMID: 28606126; PMCID: PMC5469041.
21. Hida T, Nokihara H, Kondo M, et al. Alectinib versus crizotinib in patients with ALK-positive non-small-cell lung cancer (J-ALEX): an open-label, randomised phase 3 trial. Lancet. 2017;390(10089):29-39. doi: 10.1016/S0140-6736(17)30565-2. PMID: 28501140.
22. Yao ZH, Liao WY, Ho CC, et al. Incidence of hepatitis B reactivation during epidermal growth factor receptor tyrosine kinase inhibitor treatment in non-small-cell lung cancer patients. Eur J Cancer. 2019;117:107-115. doi: 10.1016/j.ejca.2019.05.032. PMID: 31279301.
23. Viganò M, La Milia M, Grassini MV, et al. Hepatotoxicity of Small Molecule Protein Kinase Inhibitors for Cancer. Cancers (Basel). 2023;15(6):1766. doi: 10.3390/cancers15061766. PMID: 36980652; PMCID: PMC10046041.
24. Zhou F, Yang Y, Zhang L, et al. Expert consensus of management of adverse drug reactions with anaplastic lymphoma kinase tyrosine kinase inhibitors. ESMO Open. 2023;8(3):101560. doi: 10.1016/j.esmoop.2023.101560. PMID: 37230029; PMCID: PMC10225873.
How to Cite
Juncu, S. S., Trifan, A. V., Minea, H., Avram, R.-I., Cojocariu, C., & Singeap, A.-M. (2023). From spotlight to shadow: ALK inhibitor-induced acute liver failure in a patient with non-small cell lung cancer. Archive of Clinical Cases, 10(4), Arch Clin Cases. 2023;10(4):160-163. https://doi.org/10.22551/2023.41.1004.10266
Issue
Vol. 10 No. 4 (2023)
Section
Case Reports

Archive of Clinical Cases is protected by copyright and may be used in accordance with copyright and other applicable laws. Content available at www.clinicalcases.eu and our digital applications is intended for personal noncommercial use.

Authors who submit a manuscript for publication in Archive of Clinical Cases agree to the following terms: a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) only after the final version of the manuscript was accepted and published, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). d. It is compulsory that before submission authors ensure that their work was not published in any other medical journals or pending acceptance for publication and that "Archives of Clinical Cases" is the only beneficiary at that moment if their work/case will be accepted by us.

Guidelines for linking to www.clinicalcases.eu a. The main purpose of the site linking to the Archive of Clinical Casess site should be educational. b. Links should be made to the Archive of Clinical Casess home page (www.clinicalcases.eu) or to the articles abstract. c. It is forbidden to use the Archive of Clinical Casess cover by outside organizations unless permission has been granted in advance, notifying our Secretary. d. Material owned by the Archive of Clinical Cases (including the name, logo, cover, and text) may not be used in any manner that may induce the idea or suggest that the Archive of Clinical Cases is in some way recommending a specific company, product or service. e. You must not use or allow others to access or use, all or any part of our Site or the contents and/or applications on it for commercial purposes without our permission. To seek permission to do anything prohibited by or not contained in these TERMS, or which requires our prior consent or agreement, you can contact us.

How to Cite

Juncu, S. S., Trifan, A. V., Minea, H., Avram, R.-I., Cojocariu, C., & Singeap, A.-M. (2023). From spotlight to shadow: ALK inhibitor-induced acute liver failure in a patient with non-small cell lung cancer. Archive of Clinical Cases, 10(4), Arch Clin Cases. 2023;10(4):160-163. https://doi.org/10.22551/2023.41.1004.10266